Provider Demographics
NPI:1073802336
Name:IWELUNMOR, LAWRENCE OGOR (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:LAWRENCE
Middle Name:OGOR
Last Name:IWELUNMOR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 IROQUOIS AVE
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-1545
Mailing Address - Country:US
Mailing Address - Phone:734-578-5866
Mailing Address - Fax:
Practice Address - Street 1:15105 SAINT CLAIR AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44110-3719
Practice Address - Country:US
Practice Address - Phone:216-451-6260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03329158183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist